Healthcare Provider Details

I. General information

NPI: 1568288892
Provider Name (Legal Business Name): COREVITAL WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 CAMPBELLTON RD SW STE 103
SOUTH FULTON GA
30331-8014
US

IV. Provider business mailing address

5835 CAMPBELLTON RD SW STE 103
SOUTH FULTON GA
30331-8014
US

V. Phone/Fax

Practice location:
  • Phone: 404-549-2505
  • Fax:
Mailing address:
  • Phone: 404-549-2548
  • Fax: 470-780-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHERDINA HOBSON
Title or Position: PRACTICE OWNER
Credential: NP
Phone: 404-549-2505